Caldeira Vanessa Maria Horta, Silva Júnior João Manoel, Oliveira Amanda Maria Ribas Rosa de, Rezende Seyna, Araújo Leonardo Atem Golçalves de, Santana Marcus Ribeiro de Oliveira, Amendola Cristina Prata, Rezende Ederlon
Terapia Intensiva do Hospital do Servidor Público Estadual, São Paulo, SP, Brazil.
Rev Assoc Med Bras (1992). 2010 Sep-Oct;56(5):528-34. doi: 10.1590/s0104-42302010000500012.
The aim of the study was to evaluate criteria used in clinical practice, for screening of patients for ICU admission.
Cohort prospective study in a tertiary hospital. Four groups were compared in relation to ICU admission by ranking priorities into groups 1, 2, 3 and 4; highest priority 1, lowest priority 4.
Enrolled were 359 patients, 66 (53.2-75.0) years old. APACHE II was 23 (18-30). The ICU made available 70.4% of beds. Patients who were refused beds in the ICU were older, 66.2 ± 16.1 versus 61.9 ± 15.2 years of age (p= 0.02) and the priority 1 group had less refusal of beds, which means, 39.1% versus 23.8% had beds refused (p=0.01). The opposite occurred with priorities 3 and 4. Patients in priority 3 and 4 showed older ages, score system and more organ dysfunctions as well as more refusals of beds. ICU mortality rates were higher for priority groups 3 and 4 when compared to 1 and 2 priority groups, 86.7% versus 31.3% (p<0.001).
Age, score system and organ dysfunctions were greater in priority groups 3 and 4 and these were related with refusal from the ICU. Patients refused admission to the ICU showed higher mortality rates and these remained higher among priority groups 3 and 4 even when patients were admitted to the ICU.
本研究旨在评估临床实践中用于筛选入住重症监护病房（ICU）患者的标准。
在一家三级医院进行队列前瞻性研究。通过将优先级分为1、2、3和4组来比较四组患者的ICU入住情况；优先级1最高，优先级4最低。
共纳入359例患者，年龄66（53.2 - 75.0）岁。急性生理与慢性健康状况评分系统（APACHE II）评分为23（18 - 30）。ICU病床使用率为70.4%。被拒绝入住ICU的患者年龄更大，分别为66.2±16.1岁和61.9±15.2岁（p = 0.02），且优先级1组的床位拒绝率较低，即39.1%对比23.8%的床位被拒绝（p = 0.01）。优先级3和4组情况相反。优先级3和4组的患者年龄更大、评分系统更高、器官功能障碍更多，床位拒绝率也更高。与优先级1和2组相比，优先级3和4组的ICU死亡率更高，分别为86.7%对比31.3%（p < 0.001）。
优先级3和4组患者的年龄、评分系统和器官功能障碍更为严重，这些与被ICU拒绝有关。被拒绝入住ICU的患者死亡率更高，即使这些患者最终入住了ICU，优先级3和4组的死亡率仍然较高。
